Our Workers’ Comp Community: The Weight of One Opinion

Thought Leadership

May 1

BY JOHN MOLINAR

In my last post, I wrote about the growing role of technology, data, and artificial intelligence in the future of workers’ compensation. Those tools will undoubtedly influence how claims are evaluated, how medical care is analyzed, and how disputes are anticipated.

But even as the system evolves, one thing will remain true. At critical moments, workers’ compensation still turns on human judgment.

In Texas, that judgment often rests on the shoulders of a single medical professional whose opinion can redirect the course of a claim: the designated doctor.

If this blog series has a mission, it's to talk plainly about parts of the workers’ compensation process that make all of us lean back in our chairs and say, “Surely there is a better way.”

Few aspects of the Texas system carry more influence, or generate more debate, than the designated doctor process. In theory, the designated doctor is a neutral medical referee appointed by the Division of Workers’ Compensation to resolve disputes.

In practice, that one report often becomes the hinge on which the claim swings.

Maximum medical improvement (MMI). Impairment rating. Extent of injury. Disability.
Return to work. One opinion that can redirect the course of a claim.

That is a great deal of responsibility to place on one set of eyes, one set of hands, and one narrative report prepared by a physician trying to make sense of a file that sometimes reads like a novel written by five authors who never met. That is why this issue deserves daylight.

What the System Gets Right

Let’s give credit where credit is due. The designated doctor concept is noble.

When it works, it reduces chaos. It limits dueling experts. It narrows disputes. It provides a neutral medical voice when trust between the parties has evaporated.

It’s also meant to protect injured workers and carriers alike by making the evaluation process more objective. That is the point. Not to favor one side. Not to punish the other. To give the system a referee when the game starts to get ugly.

And when the designated doctor is thorough, well-trained, clinically grounded, and careful with the record, the process can feel like a relief. The report may not make everyone happy, but it feels earned. It feels coherent. It feels like someone actually read the file and examined the patient. That is the system at its best.

Why the System Draws Fire

But the same weight that gives the role its authority also creates tension.

The designated doctor process sits at the crossroads of medicine, law, and human emotion. Add strict timelines, the weight of the report, and the reality that parties often feel bound by a single examination, and frustration becomes understandable.

The friction begins with the stakes. A single report carries presumptive weight. Entire benefit trajectories can pivot on that opinion. When parties feel confined by the conclusions of one brief encounter, tension is inevitable.

Then there is participation. The pool of designated doctors has narrowed over time. Fewer participants mean greater volume for those who remain. Greater volume can create time pressure. Time pressure can produce template thinking. Template thinking erodes confidence.

A system designed to create trust cannot thrive if too many participants quietly lose faith in how it operates.

The Chiropractor Question Without Cheap Shots

Now let’s address what everyone acknowledges, but no one knows how to fix.

Chiropractors have become a significant presence in the designated doctor system, particularly in musculoskeletal cases. That shift is reflected in publicly available data. The change itself is not automatically good or bad. Chiropractors can be diligent examiners and thoughtful evaluators.

The concern is not personal. It is structural.

When one license type becomes dominant in a role that carries presumptive weight across complex disputes, questions naturally arise about consistency of methodology and the handling of cases that extend beyond straightforward musculoskeletal injuries.

The system also creates its own gravity. If fewer physicians are willing to participate, the exams don’t disappear. They are redistributed. More volume concentrates on fewer designated doctors. Over time, that can produce rushed reports, formulaic reasoning, and a perception that outcomes are becoming predictable.

The designated doctor role is demanding, time-consuming, and often thankless. It requires training, testing, familiarity with guidelines, careful record review, and narrative writing that satisfies both medical and legal scrutiny.

A doctor who performs that role well earns respect across the aisle. A doctor who performs it poorly can disrupt a claim for months or even years. Given the stakes, the system cannot afford to be casual about who performs these exams, how they are trained, how they are selected, and how quality is measured.

What Other States Teach Us

Other jurisdictions wrestle with similar pressures, and their approaches offer useful contrast.

California relies heavily on Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs). When disputes arise over issues like maximum medical improvement, impairment, or apportionment, the system turns to specialty-matched medical-legal evaluators selected through structured panel or agreement processes.

Florida takes a different path. The system centers on the authorized treating physician and party-selected Independent Medical Examinations. When genuine conflicts in medical opinions arise, the Judge of Compensation Claims may appoint an Expert Medical Advisor, whose opinion is presumed correct unless overcome by clear and convincing evidence.

Different models. The same underlying goal. Confidence in the medical evaluation that drives benefits.

Other states often design their systems around predictable pressure points. Specialty matching matters.

Neutrality must be visible, not merely asserted.

Methodology must be consistent enough that parties understand how the conclusion was reached, even when they disagree with it.

Texas does parts of that well. The growing frustration suggests we can do better.

Where AI Can Help

Even if the structure remains, the tools supporting it can improve.

Artificial intelligence should not determine maximum medical improvement. It should not assign impairment ratings. It should not decide extent of injury.

But AI can help humans perform those tasks more consistently and transparently. AI can flag internal inconsistencies in a narrative report. It can identify when the treatment summary conflicts with the medical record. It can prompt clarification when required questions are answered vaguely. It can help ensure that reasoning is structured and traceable.

It can also identify statistical outliers in patterns that warrant closer review, not as an accusation, but as an invitation to examine methodology and training. In other words, AI can help reduce the number of reports that leave everyone asking whether they read the same file.

And if AI can prevent even one designated doctor report from reading like it was dictated in a moving elevator with a dying microphone, we will have made progress.

The Participation Problem

Perhaps the most pressing structural issue is increasing M.D. and D.O. participation in the designated doctor program. If fewer physicians are willing to serve, volume concentrates and diversity of clinical perspective shrinks.

Reimbursement for designated doctor exams has increased. That is a step in the right direction. There has reportedly been some increase in M.D. and D.O. participation. But it has not yet meaningfully reshaped the landscape.

So why have so many physicians stepped away? Administrative burden. Testing frustration. Time demands. Reimbursement concerns. The reality that no matter how carefully an opinion is written, someone will challenge it.

If participation is the core issue, we need to keep asking practical questions. What would make this role sustainable? What would make it professionally worthwhile? What would restore broader physician engagement? Until we ask and listen, we are simply assuming. And a system this critical cannot afford to run on assumptions.

Is the Process Broken?

I do not believe the Texas designated doctor system is beyond repair. But it clearly needs mending.

The designated doctor role is too important to be treated as a procedural checkpoint. It shapes care, benefits, and return-to-work outcomes. It deserves thoughtful refinement.

Broader participation.
Clear expectations.
Better guardrails.
Less unnecessary friction.

Because when one opinion carries this much gravity, the system must ensure that opinion feels earned.

The designated doctor system is worth keeping. It is also worth improving.

Improvement doesn’t happen by accident. It happens when we decide the weight is too important to ignore.

That conversation is worth having.

Pull up a chair.

Let’s get to work.

AUTHOR

John Molinar is a Board Certified Workers’ Compensation attorney and industry leader, offering practical insight shaped by decades of experience across the Texas system.

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